EVALUACIÓN

The regime transition in South Africa from a white dominated to an inclusive government that va lued social transformation created fertile ground for Cuban humanitarian engagement, specifically medical diplomacy. Apartheid formally ended with the 1994 parliamentary elections, in which black South Africans were included among the enfranchised (Schwartzman). This new government began to slowly transform South African society. A chief means of this is to improve the horrible condition of medical care in the rural areas. In 1996 the South African Health Minister welcomed the first group of Cuban doctors to his country, “We are now struggling for the transformation of society so that we can provide basic needs to our people. Cuba is very much part of that struggle” (Lee). Cuba has used medical diplomacy to strengthen an ally in order to solidify political support and hopes to benefit from possible future trade agreements.

South Africa has many public health deficiencies that Cuba has been able to alleviate using its medical power through medical diplomacy. The two main problems that the South African Health Ministry faces are a shortage of doctors (especially in the rural areas) and a lack of medicines (especially AIDS medicines). Rural provinces like the Eastern Cape Province have a doctor to population ratio of 1:10,000. The World Health Organization (WHO) recommends a minimum ratio of 1:1,000 (Global News

Wire, 07 Feb 2001). In 1996 there were about 2000 vacant doctor positions in rural areas (Lee). Affordable medicines and basic vaccines are in extremely short supply. AIDS retroviral drugs are very expensive and so make their use in treating the large infected population prohibitive. Cuba’s supply of quality doctors, medial scholarship program, and expertise in biotechnology are well- suited solutions to South Africa’s public health problems.

The general distaste of South African doctors for working in the rural provinces made Cuban medical assistance very attractive. Young medical school graduates, who must all perform some community service, scramble for jobs in the city of Cape Town. Of the young doctors who do perform their service in the rural communities, few stay. Provincial health officials cite the lack of senior mentors, inadequate medical facilities, and poor living conditions (Global News Wire, 13 March 2001).

South Africa has found Cuban doctors a good solution to this immediate problem. According to Dr. Bevan Goqwana, head of public health in the Eastern Cape Province, “Many South African doctors, especially young graduates, are unwilling to work in rural areas. Most of the doctors who work in these areas are foreign doctors, the majority being Cuban and Asian doctors” (Global News, Wire 07 Feb 2001). Cuban doctors in South Africa received praise from Cuban and South African health officials alike. South African Health Minister Manto Tshablala-Msimang made statements that “Cuban doctors have provided outstanding service in the rural areas”(Global News, Wire 27 March 2001) and “There has been improvement in the quality of treatment in almost every hospital where we have deployed Cuban doctors” (Global News Wire, 30 Mar 2001b).

The outstanding performance of Cuban doctors in South Africa was more than sufficient to initiate a more lasting medical cooperation agreement between the two countries. In March 2001 an agreement between the South African and Cuban Health Ministries was signed covering all of the critical South African public health problems. These include the recruitment of doctors, the training of medical students, an exchange training program for medical researchers and specialists, and an improved exchange of medical technology (Global News Wire, 30 Mar 2001b).

The South Africa-Cuba medical agreement was signed despite domestic opposition groups in South Africa. The Rural Doctor’s Association of South Africa opposed the government’s use of foreign doctors. Chairman Ian Cooper stated the government needed to “stop paying lip service” to keeping South African doctors in the country. His organization advocated laws restricting the use of foreign doctors and expanded programs for domestic physicians. These programs include better financial incentives, specialist training, and bringing back doctors who had emigrated from the country. The Association admitted that the Cuban doctors had helped but that they lacked ge neralist skills like anesthesia and were limited by their different culture and language (Global News Wire, 13 Mar 2001).

South Africa embraced Cuba’s offer of medical scholarships as a good short-term solution to their shortage of rural doctors. A Health Ministry official stated, “Sending students to Cuba is not an end in itself, but is a short-term means to addressing imbalances in these areas”(Global News Wire, 07 Feb 2001). Students are selected from rural areas for a seven- year scholarship to Cuba’s Latin America School of Medicine. In return they agree to seven years of government service in rural clinics. The program began in 1997 with 61 students. Health Minister Manto Tshablala-Msimang addressed the students, “You are going with a challenge, a mission, and you must fulfill it…Without this opportunity you would never have the opportunity to study medicine” (Global News Wire, 06 Sept 2000). In March 2001 the Health Ministry argued with the Health Profession Council that just as exiled doctors are not required to take medical exams to register in the country, so medical students in Cuba who have been disadvantaged by apartheid should not be required to take the exams as well (Global News Wire, 30 March 2001b).

Cuba’s expertise in biotechnology was able to help address South Africa’s shortage of medicines. The South African Health Minister described his country’s biotechnology goal as, “To ensure an adequate and reliable supply of safe, cost-effective drugs of acceptable quality to all South Africans and for all the diseases that continue to pose major health challenges to our country” (Global News Wire, 30 Mar 2001a). This can be interpreted to mean that the importance of patent rights is secondary to that of the health of the population. In March 2001 Castro offered to assist South Africa in

producing generic drugs of their own. The Health Minister replied, “We are going to examine this. It is very interesting to us” (Global News Wire, 27 Mar 2001). This offer was followed by a visit to Cuba by South African President Thabo Mbeki. During this visit he made an agreement with Castro to cooperate on the production of AIDS drugs and ignore patents (Global News Wire, 30 March 2001a). Subsequently South Africa’s Medicines and Related Substances Control Amendment Act was challenged by multi- national-corporations in the country’s Pretoria High Court for eroding patent rights (Global News Wire, 30 Mar 2001a).

Cuba has benefited from its use of medical diplomacy to South Africa with increased trade and especially political support. Although absolute levels of trade are low, Cuban exports and imports to South Africa have increased from 1996 (the beginning of Cuban medical diplomacy) until 1999: exports rose from 0 to $2 million and imports rose from $17 to $23 million (Central Intelligence Agency). Political support has been through South Africa’s vote on the United Nations Human Rights Commission. It has held a seat on the Commission five out the last six years (1997-2002). Every year South Africa has voted against the resolution to censor Cuba for human rights violations (see Figure 2).

Internal changes within the South African government made it ideologically friendly with Cuba. The country sought societal transformation and chose to solicit assistance from Cuba in attaining this goal. Cuba used its medical power to assist its new ally with its terrible rural medical conditions. Cuban doctors, medical scholarships, and biotechnology expertise have proven to be more influential with the South African government than the hostile backlash from the domestic Rural Doctor’s Association of South Africa, Health Profession Council, or pharmaceutical multinational corporations. Cuban medical diplomacy led to increased trade and most importantly, political support in the UN Human Rights Commission.